WHAT IS A MIDWIFE
Midwives take care of women during pregnancy, labor, birth and the postpartum. When delivery takes place out of the hospital setting, the midwife is also responsible for taking care of the newborn. Midwives may also provide well women gynecology services.
MIDWIVES MODEL OF CARE
The Midwives Model of CareTM (http://cfmidwifery.org/mmoc/define.aspx) is based on the fact that pregnancy and birth are normal life processes.
The Midwives Model of Care includes:
- Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
- Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
- Minimizing technological interventions
- Identifying and referring women who require obstetrical attention
The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.
TYPES OF MIDWIVES
There are two types of midwife in the United States:
- Nurse-midwives are educated and licensed as nurses first, and then complete additional education in midwifery. They are known as Certified Nurse-Midwives (CNMs). CNMs are licensed to practice in all 50 states. They are usually licensed in individual states as Nurse Practitioners (NPs).
- Direct-entry midwives are educated or trained as midwives without having to become nurses first. They may be Certified Professional Midwives (CPMs) or Certified Midwives (CMs). The legal status and requirements for direct-entry (non-nurse) midwives vary from state. They are usually licensed in individual states as Licensed Midwives (LMs) or Registered Midwives (RMs). The Midwives Alliance of North America tracks the laws and regulations in each state for direct-entry midwives (http://mana.org/laws.html).
NATIONAL MIDWIFERY ORGANIZATIONS
Each of the national professional organizations plays an important part in the existence of a profession. Aspiring midwives must first receive some kind of education and clinical training. Educational programs are able to become accredited through a professional accreditation agency. Graduates can become nationally certified, which may be a requirement to obtain a license to practice in a state, province or country. Professional organizations support practicing midwives through core competencies, standards of practice, ethical guidelines, continuing education, research, advocacy and networking.
Pre-accreditation and accreditation are voluntary processes between the education program or institution and the accrediting agency. The goal of accreditation is to provide quality education so when students graduate they are well prepared to become credentialed and practice their chosen profession. Accreditation assesses the quality of education relative to the national professional core competencies and standards of practice, student services, the financial stability of the institution, and other student safeguards.
ACCREDITATION ORGANIZATIONS FOR MIDWIVES
The two organizations in the United States that provide national accreditation for midwifery education programs are:
- The Midwifery Education Accreditation Council (http://www.meacschools.org). Midwifery education programs accredited by MEAC fulfill the requirements for national certification by the North American Registry of Midwives.
- The Accreditation Commission for Midwifery Education (http://www.midwife.org/acme.cfm). Midwifery education programs accredited by ACME fulfill the requirements for national certification by the American Midwifery Certification Board.
The US Department of Education recognizes select accrediting agencies as reliable authorities regarding the quality of education or training offered by the institutions or programs they accredit. Accreditation by a recognized accrediting agency allows institutions to participate in federal student aid programs (http://www.ed.gov/admins/finaid/accred/index.html ). Both MEAC (Midwifery Education Accreditation Council) and ACME (Accreditation Commission for Midwifery Education) are recognized by the US Department of Education. MEAC’s website explains how students benefit from attending an accredited program (http://meacschools.org/prospective_students.php?ID=35).
Certification agencies are made up of consumers and experts in the profession. They develop criteria for education, training and clinical experience based on what experts in the field determine is necessary for someone to practice safely as an “entry level” practitioner. An “entry level” midwife has completed education and training to know how to care for healthy women with a normal pregnancy, labor and delivery, how to risk screen for problems, when to consult, refer or transfer care, and how to handle emergencies while getting medical help. Certification agencies administer a written examination and in some cases also a skills practicum examination.
CERTIFICATION ORGANIZATIONS FOR MIDWIVES
The two organizations in the United States that provide national certification for midwives are:
- The North American Registry of Midwives – NARM (http://www.narm.org)
- The American Midwifery Certification Board – AMCB (http://www.amcbmidwife.org )
A Certified Professional Midwife (CPM) has earned national certification through the North American Registry of Midwives (http://www.narm.org). Client continuity of care and clinical birth experiences in out-of-hospital settings (birth center or home) are required for certification. Education can be obtained through a MEAC accredited or non-accredited school or program, or through apprenticeship. Midwifery practice guidelines, an informed consent document, and an emergency care plan are required. Graduates of a MEAC accredited program must pass the NARM national written certification examination. Graduates of other educational programs or routes must complete the NARM PEP Process and pass a skills practical examination in addition to the written examination.
A Certified Nurse-Midwife or Certified Midwife has earned national certification through the American Midwifery Certification Board (http://www.amcbmidwife.org). They must complete a graduate-level educational program accredited by the Accreditation Commission for Midwifery Education (http://www.midwife.org/acme.cfm) that provides clinical birth experiences in hospitals, and pass the AMCB national certification examination.
The National Commission for Certifying Agencies (NCCA) was created in 1987 by the National Organization for Competency Assurance (http://www.noca.org) to ensure the health, welfare and safety of the public through accrediting a variety of certification program/agencies that assess professional competence. NCCA accredits over 200 programs from more than 100 organizations. NCCA accredited programs certify individuals in a wide range of professions and occupations. Both the North American Registry of Midwives and the American Midwifery Certification Board are recognized by the National Commission for Certifying Agencies (NCCA). (http://www.noca.org/Resources/NCCAAccreditation/tabid/82/Default.aspx)